Unprotected Oral & Protected Anal w/ Sex Worker

[alwaysonmymind41]

Doctor,

I'm concerned. Approximately 20 days ago, in a drunken state, I had unprotected oral (insertive) and protected anal (insertive) with a csw. The condom never slipped or broke. I have 5 questions:

1. We used cooking oil as lubricant during anal sex. After the fact, I learned that this can weaken condoms making them more prone to break. Early the next morning I fished the condom out of the trash (I know, gross) and filled it with water. Condom was virtually intact with no leakage. Still unsure if there's a slight chance that the oil might have degraded the condom to open tiny holes that may have let pathogens get through. Is there any risk here?

2. I shaved my pubic region 1.5 hours prior to intercourse (mainly the base of the penis). No visible bleeding, no lesions etc. Again, is there any risk here (unprotected shaved base may have inserted)?

3. 7 days after, 3 wart/zit looking bumps appeared on my pubic area (2 on base of penis, 1 in the pubic hair region). Worried that I contracted something, I visited a dermatologist who diagnosed me with Molluscum Contagiosum. He applied cryogenic freezing. They scabbed then came back (or never left) within a week. I went back to the dermatologist and reapplied cryogenics. He also noted that the bumps looked slightly different and could be HPV (although the Molluscum diagnosis still stands). Could this in anyway be linked to possible HIV exposure?

4. Overall, what is my risk IF the csw was HIV+?

Also, I got tested at 13 days after exposure and everything came back negative (HIV, herpes 1/2, syphilis, gonorrhea, chlamydia, hep C). The HIV test was: HIV I & II Antibody - although the lab mentioned that there was some "early detection" test included (which is not explicitly stated on the report, as only HIV I & II Antibody was) - which contradicts everything that I've read about HIV testing.

5. With these results, should I be more assured? I though antibody and early detection were different?

Thanks.

[H. Hunter Handsfield, M.D.]

Welcome to the forum. Thanks for your question.

Responding to the title, before reading anything else:  oral sex carries little or no risk for HIV, and condom-protected anal sex is safe. I'll go ahead and read the details, but most likely you aren't at risk for HIV.

Now having read it, I'll remind you of a universal theme on this forum: the vast majority of CSWs do not have HIV.  Assuming you're in the US, the odds are somewhere around 1% (1 in 100) to 1 in 1000 that your partner is infected.  To your specific questions:

1) You are correct that oil, or oil-based lubricants, can weaken condoms.  That can cause condoms to break, but it doesn't cause microscopic leaks. If the condom did not rupture wide open, you can be certain protection was complete.

2) Pubic area shaving is not likely to increase the risk of HIV.

3) Molluscum contagiosum takes at least several weeks to show up after catching the virus.  You did not catch it during the exposure a week earlier with the CSW.  You'll need to look back to sexual exposures 1-3 months earlier.

4) Even if your CSW partner had HIV, the chance you caught it was no higher than one in a million.

5) The urine (or urethral swab) tests for chlamydia and gonorrhea are reliable; you did not catch either one.  All the other tests were done too soon to know.  If an "early detection" HIV test was done, probably it was a PCR test for HIV RNA. If that was done and negative, it is reassuring -- but you still need another antibody test at 6-8 weeks.

I hope this helps.  Best wishes-- HHH, MD

[H. Hunter Handsfield, M.D.]

You're welcome.  I'm glad to have helped.

[alwaysonmymind41]

Dr. Handsfield,

My 25th day combo tests came back negative and I am done worrying about this. I appreciate your feedback and factual reassurance. You have created an amazing resource that enables people to realistically understand their risks, and not let anxiety take control. Thanks again.

[H. Hunter Handsfield, M.D.]

Your symptoms do not impress me.  They are not suggestive of HIV but sound quite typical for the physical manifestations of anxiety, stress, depression, etc.  You can expect both your current test, and any future ones you may have, to be negative.

[alwaysonmymind41]

Doctor Hansfield,

Thanks for your response. However, like many others I am VERY anxious. 25 days have now passed and I just went in to get my p24/antibody test (waiting on results). I get anxiety attacks and feel like I have a low grade fever. I am always tired and constantly checking my phone at work for symptoms. I spend most of my time thinking about the possibility of HIV and can't make distinctions between ARS symptoms and severe anxiety. I just got prescribed some low dose meds to help me relax a bit. I'm thinking the worst and can't seem to shake it. The doctor I saw didn't prescribe the right test at 13 days as it was just antibody. This did not help my fear.

Thanks.